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CPre-aPPlication Consultation Form jF�?��C- <br /> �j n]� <br /> Request For Approval— Subdivision <br /> Burnett County Land Use/Zoning Departme>d DECi <br /> ' <br /> Burnett County Government Center; Siren, Wisc sin �ll(1l <br /> BUR SON OUN71, <br /> AI G <br /> Applicant: Owner: S Vt y r AAryh e A <br /> 2 qS0 Lojy6 C414t 9P <br /> v, �i�NQuRy Wlf. s483o -4C6L <br /> Phone: 71 . Phone: 2 S 9- 3SS Z <br /> Original Parcel Information: <br /> ➢ Location of Property: N w Y, S W Y9 <br /> ➢ Section: Sip: 40 Range: J 4 Size: 34 Ac <br /> ➢ Legal Description.. <br /> g P <br /> ➢ Current Zoning: R12 Floodplaino: w`_14e4 WetlandYN. <br /> New Parcel Information:- <br /> ➢ Land Surveyor Preparing Plat/Map: A9lvr <br /> ➢ Number of Lots: 3 Proposed Zoning: Sh'�hc <br /> ➢ Regional Flood Elevation: IV�A <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, Y1 <br /> ➢ Type of Access (Example: Outlot, Easement, Etc.): '— <br /> ➢ Proposed Water and Sanitary System: PR I vATE — <br /> ➢ Proposed Use: Residential: x Commercial: Other: <br /> Date: 2A/6/ Signature: «t�C <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance: 'g�b� Action: <br /> ''TT <br /> Date of Land Use Committee Final Acceptance: Action: <br />